The proliferation of antibiotic-resistant strains of bacteria could nullify the effects of antibiotics, the miracle drugs of yesterday.
Last week, the Food and Drug Administration approved Zyvox, an antibacterial drug that is part of a first new class of antibiotics to be developed in 35 years. The drug was approved for use in the fight against several types of antibiotic-resistant bacteria.
Zyvox was effective against some strains of bacteria that were resistant to some of the strongest antibiotics currently in use. It can treat infections related to vancomycin, a very resistant strain of bacteria. However, University Hospital epidemiologist Dr. Barry Farr is somewhat skeptical as to the impact this drug would have.
"It's always great to have another new [antibiotic], but we've had a whole bunch of the them," Farr said.
Over the years, indiscriminant use of antibiotics has led to the development of bacteria that can resist drug treatment. When antibiotics first became readily available in the 1940s, they were considered miracle drugs, or "magic bullets," said fourth-year College student Adam Possner, who is doing his thesis on antibiotic resistance.
Public perceptions of the intended uses of antibiotics, Possner believes, have contributed to their improper and excessive use. Dr. Brian Wispelwey, professor of internal medicine and infectious diseases at the School of Medicine, said surveys found two-thirds of people think antibiotics can treat viral infections.
Many do not realize that antibiotics are meant only to treat bacterial infections and are not effective against viruses. In his thesis, Possner attempted to solve the problem by changing the term "antibiotic" to "antibacterial." Possner conducted a telephone survey that tested what people thought an "antibiotic" would treat, as opposed to what an "antibacterial" would. His study concluded that 44 percent of participants mistakenly believed "antibiotics" could treat viruses. However, when antibiotics were identified as "antibacterials" they were more likely to say antibiotics could not effectively treat viruses.
He concluded if a more specific term such as "antibacterial" were used, people would not be mistaken to think that antibiotics could treat viral infections such as colds.
The public misperception of antibiotics may have indirectly created multi-drug resistant bacteria which have become harder to fight. The perception of it as a miracle drug has led to its overexposure to the body, which can have negative effects, since it may actually promote the growth of resistant strains. The antibiotic accomplishes its initial task of killing off non-resistant bacterial cells. However, the environment is left with resistant bacteria that are now less competitive for resources. This gives resistant strains a better chance to reproduce and spread because antibiotics have killed off all competition.
"It's really Darwinism at its best - or worst," Possner said.
Additionally, bacteria can share resistance. "They don't just develop the new strain [of resistant bacteria], they also spread just like we spread a cold virus from person to person to person," Farr said.
This spread of resistant bacterial strains is a particular problem in the hospital setting. Farr said that half of all hospital-acquired infections are antibiotic-resistant.
"The hospital is the highest-risk place for generating and spreading such stuff," he said.
Farr and Dr. J. Owen Hendley, Chief of the Division of Infectious Diseases at the University Children's Medical Center, both said that another part of the reason antibiotics are over-prescribed stem from physician error in misdiagnosing the cause of infections.
Possner said that one of the key factors is the mistaken prescription of antibiotics for viral infections, when they are meant to treat bacterial infections only.
In addition, Farr and Hendley said doctors might feel pressure from patients to misprescribe antibiotics. Hendley says day care centers promote the overuse of antibiotics and the spread of antibiotic-resistant bacteria, because parents of daycare children will pressure doctors to prescribe antibiotics, thinking it will cure them.
"Yes, there is clear pressure. The parents have gone to the trouble to bring the child in - they'd like something done," Hendley said.
Hendley said children often get over-diagnosed because many day care centers require children with infections to be taking antibiotics in order to return. This is under the assumption that the children will not be able to spread the infection while on antibiotics. In such cases, pediatricians may be pressured to misprescribe and over-prescribe antibiotics to children.
To combat the problem of antibiotic-resistant bacterial strains, the University Hospital, like hospitals across the country, has implemented programs to educate and increase awareness on the issue. This is in addition to both the Centers for Disease Control and American Medical Association's efforts, which have sent out brochures and posters in an effort to educate the public, Possner said.
A Hospital Antibiotic Control Team also has been implemented to provide advice on antibiotic use in the hospital. Farr said efforts are being made to identify resistant strains so barrier precautions can be used for patients carrying them. Barrier precautions involve the use of gloves, gowns, masks and other protective devices by hospital staff to prevent the spread of bacteria. Studies have shown that using barrier precautions can decrease the spread of infections 16-fold, Farr said.
Even new drugs such as Zyvox, which was effective in treating 68 percent of the antibiotic-resistant bacteria enterococcus, may not be the answer, Wispelwey said. It is becoming evident that the development of new drugs alone will not curb the problem, since the newer challenge of fighting antibiotic resistance has arisen.
"More will die if these trends continue," Farr said.
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